The Opposite of Tenebrific


A career in medicine is one that has many lures–the ability to touch lives,  fascinating medical phenomena, and the knowledge of the complexity that comprises the human body, among other things.  Yesterday, every single one of my patients reminded me again of why I became a PA.  One patient asked my advice on what to do about a lost love connection spanning over 20 years.  Another had such an intricate medical history, it had me stretching my brain for information I’d learned long ago in school.  One funny patient and I talked about our love of words, and I shared with him an app on my phone which gives me a new word to learn every morning. Every patient thanked me for being easy to talk to, and I was loathe to walk each of them to my door because I had enjoyed our visit so much.  It was a day sorely needed. Last week, the last patient of my day made me cry.

As anyone who knows me will tell you, making me cry is not actually difficult. I confess to a small sob while watching the movie Aladdin (which is a cartoon I know, but that Genie gets me every time).  aladdin genie

Someone else crying causes me to tear up.  Even writing a sentence about crying will cause what my son calls my “shiny eyes.” I’ve cried with patients numerous times, with a touching story or in shared grief. But this time, it was different.  I was crying tears of anger.  I am cursed with full-on waterworks if I’m extremely angry, which I would love to be able to control. It’s hard to be taken seriously if you’re wiping away tears while trying to make a point, and even harder to carry on a patient evaluation when you are doing everything you can to remain professional in the face of hostility.

This patient began our encounter angry before he had even met me because his appointment had been rescheduled with another provider. Where I work, I’m used to dealing with angry patients on an almost daily basis.  To some of them, solely on the basis of where I work, I am the face of all of the bureaucratic bean-counting, soul-sucking paper-shuffling nonsense that prevented them from seeking care in the first place. I am part of the system that denied them benefits, told them PTSD did not exist, and denied their right to be seen as a person, and not a number. So I understand the frustration and the anger that comes as part of the baggage of just getting to the appointment.  I understand that part of my job is to lift that burden of frustration, and make them feel like they are seen, and heard.

As patients, we come to our appointments carrying the invisible baggage of our history–the memory of an aunt who died on the operating table, medication reactions, a fear of bad news-“What if it’s cancer?” As providers, we know this, and try our best to gauge those worries and try to alleviate them if possible.   Sometimes though, the actions brought about by those fears and worries are inappropriate, and other times, even criminal.  Fears have been running high in our department because one of our sister facilities suffered a tragic shooting.  A patient shot and killed one of the providers at the hospital in El Paso.  He worked in the same type of department in which I work.   Meetings about safety measures, active shooter scenarios, and how to deal with violence in the workplace have been laced with tension-filled voices.  One of our police officers tried to help us dial back the emotions.  “Let’s not call it a panic button. I prefer the name duress alarm. We don’t want to have panic,” she said.  I’m not sure that changing the name makes a difference, though I do advocate for the power of words.

But the words I mean are those we use when dealing with patients.  As peace-loving as I try to be, I am not immune to the effects of violence. I trained in the city of Detroit and saw the ravages of drugs and violence on the faces and bodies of our patients, treated gunshot wounds and stab wounds, and saw families ripped apart by random acts of killing.   People argue that our patient population is more dangerous because as veterans,  our patients have all been trained on how to use weapons.  I argue that if anything, that makes us safer, because they were also trained in how to defend those in need, in how to stand and fight for those who could not or will not because of an oath to heal or religious convictions or even conscience alone.  I will defend our veterans as patients just as worthy of our compassion as any other patients, if not more, and not to be considered a source of fear.

Last Friday though, I was afraid, and if I were a superstitious type, might have seen the word of the day, “tenebrific,” as a portent, as it means producing darkness. My patient arrived upset, out of control, and angry with me and everyone else in his vicinity.  I stand a whopping 5 foot nothing, and so to me, everyone is tall.  This man though, stood a good foot taller than me, and weighed over 2 times what I weigh.  I tried every tactic I had ever used to deal with a difficult patient, but I could not connect with him.  The power of words failed me.  He kept standing up while I was attempting to gather his history, and the sight of this very large man gesticulating wildly between me and the door gave me a qualm every time he stood up.  Between his wife and I, we tried to calm him down, but nothing seemed to work.  He alternated between insulting me and denigrating the system, and I bit my tongue and tried to smile pleasantly until it reached the point that he started to use expletives.  I firmly told him that this kind of language was unnecessary.  At this point he demanded to see someone else because he thought I was “belligerent and argumentative.”

My hands shook and my heart was pounding as I escorted him to the appointment desk to be rescheduled, and then I returned to my office and promptly burst into tears. I was angry and upset, mostly at my inability to control the situation and at the fact that I had not been able to get him to see beyond me as the face of an organization, to see me as someone who cared about his well-being, and at myself for feeling intimidated by a patient.

I believe strongly that all patients deserve good health care, the best that I can provide if possible.  To come to a point where I could not do so, made me realize that as providers we also have the right to be treated with dignity.  When we in good conscience have done all we can to do right by our patient, we also deserve to be seen and heard. We deserve, as our patients do, to work in a place where we should not fear for our lives for doing our jobs.  My heart goes out to those in El Paso, and especially the family of the man who was killed trying his best to help others.

Today I am thankful for work which allows me to be present in the lives of others in the midst of their pain and suffering. I pray for the strength to continue to be the opposite of tenebrific as much as possible.  And I am grateful for all of the wonderful patients I’ve met along this journey.

I would love to hear any of your stories of how you’ve either dealt with a difficult person or tactics on how to keep the tears from flowing when you don’t want them to.  I hope and pray that you have someone taking care of you with whom you can laugh and cry. Let them know you appreciate them if you do.  They might really need to hear it today.

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